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Ethical Dilemma: Bus driver with hypoglycaemic attack

Discussion in 'General Issues and Discussion Forum' started by mature student, Jan 12, 2010.

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    Hello Everybody,

    This is my first post and am looking for some advice. I am a student and am seeking to find out how you would deal with this situation...and whether it would be classed as an ethical dilemma?

    If you was treating a type 2 diabetic with an ulcer and he had a hypo in clinic as well as admitting that he is not looking after himself or testing his blood sugars how would you proceed.? He is also a coach driver and is going back to work after his treatment??

    Thanks all...
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Re: Ethical Dilemma?

    In some countries, you can NOT get a drivers license to drive coach's if you using insulin.
     
  3. Re: Ethical Dilemma?

    Hello

    He is on tablets for his diabetes.. he drives in UK
     
  4. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Re: Ethical Dilemma?

    Hypos are way less common in those with some residual beta cell function... which is probably all those on oral agents. It is only those on insulin, in some countries, that have occupational restrictions on them (as bad as that may be).
     
  5. twirly

    twirly Well-Known Member

    Re: Ethical Dilemma?

    Hi mature student,

    I would contact the patients GP for advice. If his diabetes is poorly controlled his Dr. may want to reassess his medications. I believe the patient is legally bound to notify the DVLA if medical status alters which may affect his ability to drive.

    http://www.dft.gov.uk/dvla/medical/ataglance.aspx
    Interested to know how you go on.

    Regards,

    Mandy.
     
    Last edited: Jan 12, 2010
  6. Ella Hurrell

    Ella Hurrell Active Member

    Re: Ethical Dilemma?

    Hi Mature Student

    This is a sadly all too common occurance. I doubt this is unique to the UK either. I can understand why you would be so concerned about him but I have to agree with my colleagues above - the best thing you can do is advise the patient within your remit of knowledge ie. why glucose control is important etc and have a tactful word with his GP. Unfortunately ;) patients have free will and you can't save everyone from themselves :bang: As a coach driver, this isn't just about him now though - you'd hope he'd have more of a sense of responsibility for his passengers!

    Good luck!
     
    Last edited: Jan 12, 2010
  7. Graham

    Graham RIP

    Re: Ethical Dilemma?

    This chap may not have sick benefits and needs to work to support his family. He should be strongly encouraged and educated that if he continues as is he is likely to lose his leg and his job. Be positive. Tell him what you can do for him and don't be judgmental. do everything you can for him to encourage his improved compliance.

    Don't forget he may also have a cognitive deficit disorder (frontal lobe ischaemia) due to his diabetes and may be unable to assimilate new information in the usual manner. If you have access to a psychologist they may be able to give you some strategies to help improve compliance and outcomes.
     
  8. Marion A Murray

    Marion A Murray Active Member

    Re: Ethical Dilemma?

    Having attended the excellent medico-legal training sessions in UK, I would think you have a legal duty to inform the DVLA as his fitness for his role may endanger other road users or passengers, etc. However, I would contact the GP first to ensure the man is given access to counselling or a CBT psychologist under the Long Term Conditions system and re-routed to the multi-disciplinary diabetic specialist team to help him understand the importance of self-care, compliance with medication, impact of food, exercise, stress and the mechanisms leading to a hypo, etc.

    You might find 'Clinical Responsibility' a book by Jane Lynch a useful purchase for ongoing reading in this type of area. Or SoCaP are repeating the medico-legal training sessions later in the year so you could raise issues with the highly proficient solicitor/advocate. Although they do not discuss live cases as such and have a tight timetable for the training so diversions are minimised...
     
  9. cornmerchant

    cornmerchant Well-Known Member

    Re: Ethical Dilemma?

    Marion

    Forgie me if I am wrong, but is it not a legal requirement that you get consent from the patient before you contact his GP?

    Regards
    Cornmerchant
     
  10. Marion A Murray

    Marion A Murray Active Member

    Re: Ethical Dilemma?

    I am not sure. Obviously it would be good practice if the person themselves agrees to contact DVLA on recovery from the hypo. I think the case we discussed was someone who had lost capacity with advanced Alzheimers and in some occasions took the car out.

    Maybe by contacting the GP a podiatrist can circumvent the requirement but what if he had has another hypo and causes a serious accident meantime.

    It is a tricky one as no-one wants their livelihood threatened but we have to be honest and act in ways with integrity...
     
  11. Re: Ethical Dilemma?

    Thank you to all who have replied. You have given me some good issues to think about...this will be a good case to present !

    Legally do you need consent from the patient to contact the GP?? If the patient objects, where does that leave you when surely you have a duty of care to him and his passengers?

    Lots to think about on this I think. ..!
     
  12. blinda

    blinda MVP

    Re: Ethical Dilemma?

    Cornmerchant;

    You took the words right out of mouth...I tend to ask the patient on their first appointment if they consent to me communicating with their GP and they sign their medical records to signify this.
     
  13. twirly

    twirly Well-Known Member

    Re: Ethical Dilemma?

    Hang duty of care. :bash:

    My duty of care is now getting a little hacked off with the 'is it okay brigade!' This idiot could be driving a bus with my family aboard. I'd deal with the flack AFTER I contact the GP for further advice!

    On a personal note: If (big IF) an accident occurred following this man becoming unable to drive following a medical event YOU were aware of then YOU justify your lack of action!

    Common sense please.

    World's gone barmy.
     
  14. blinda

    blinda MVP

    Re: Ethical Dilemma?

    Bad day Mand`?:empathy:
     
  15. cornmerchant

    cornmerchant Well-Known Member

    Re: Ethical Dilemma?

    I think this needs to be kept in proportion- there is no reason to suppose that this type 2 patient has frontal lobe ischaemia, nor is there evidence to prove that he is not safe to drive. We dont know how bad the hypo was , he probably had skipped a meal to get to his appointment between work.

    What is required is an in depth chat about his diabetes with him- I have many patients that have never had a good explanation of their disease nor its implications- and yes if need be, put the wind up him if he is in a job that puts other people at risk. The worst thing is when a patient comes ,who has recently been diagnosed and tells me that he is only borderline diabetic! ie the message he has recived is that it is not serious and very mild -ergo he doesnt need to worry too much!

    Regarding GPs- it is a legal requirement to get the patients permission to contact GP due to the data protection act. I tend to ring the GP with major concerns as it is quicker and they prefer it. That said , I always ask the patient for their consent .

    Cornmerchant
     
    Last edited: Jan 12, 2010
  16. twirly

    twirly Well-Known Member

    Re: Ethical Dilemma?

    <nods>

    Not aimed at you Bel,

    Baaaaaaaaad day.

    Getting up to back teeth with PC brigade. ;)

    Normal (ish) transmission will resume shortly. :empathy:

    Xs Mand'
     
  17. Graham

    Graham RIP

    You appear somewhat out of date! Cognitive deficit disorders are a major complication in our patients with diabetes and if not recognised place aserious barrier to improved outcomes.
     
  18. cornmerchant

    cornmerchant Well-Known Member

    Thanks for pointing that out Graham, However, I tend not to jump to conclusions before I have the full picture and in this case we certainly have very little to go on.


    Cornmerchant.
     
  19. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    This just appeared today in ScienceDaily:
    Healthcare Professionals Failing to Tell Patients They Are Not Fit to Drive, UK Study Finds
    Full story
     
  20. Thanks Newsbot for your information. Its vdry interesting and shows the
    lack of knowledge in this area.

    I did my ethical reasoning presentation and think it went well. When investigating
    this issue I certainly learnt a lot about the rules and regulations that should be followed.

    I still think it is a very grey area, but extremely important and maybe steps will be taken to improve the situation. Lets hope....

    Thanks again to all of you who responded, this is a great site and I will be a frequent visitor for definite! :dizzy:
     
  21. Joseph Haslam

    Joseph Haslam Member

    Hi Mature Student, I can see the problem in deciding on your course of action with the diabetic driver. I had a somewhat simular situation some time age when I attended a truck driver who had driven up onto a public side walk and just missed hitting a lamp post. He admitted to me that he was an epileptic and was not taking his medication. He asked me not to report him to his employer as he feared the loss of his job, but later addmitted that this was not the first time that he had such an episode. In this instance I felt that my obligation was clear and that I must report the situation to his boss. I considered the risk of his killing some one as against the loss of his job, hard on him as that may be, but in this case the moral duty was clear. I never learned what the eventual outcome was. I may add that the man was not a patient of mine and I encountered him only when I went to see if he was hurt. (I am a trained paramedic.)
     
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